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Total Laparoscopic Uncut Roux-en-Y for Radical Distal Gastrectomy: An Interim Analysis of a Randomized, Controlled, Clinical Trial.

全腹腔镜未切割 Roux-en-Y 行根治性远端胃切除术: 一项随机、对照、临床试验的中期分析。

  • 影响因子:3.60
  • DOI:10.1245/s10434-020-08710-4
  • 作者列表:"Wang J","Wang Q","Dong J","Yang K","Ji S","Fan Y","Wang C","Ma Q","Wei Q","Ji G
  • 发表时间:2020-06-18
Abstract

BACKGROUND:The traditional Billroth II and Roux-en-Y anastomosis after laparoscopic distal gastrectomy for gastric cancer are associated with bile reflux gastritis and roux stasis syndrome, respectively. The uncut Roux-en-Y gastrojejunostomy can decrease the incidence of these complications by blocking the entry of bile and pancreatic juice into the residual stomach and retaining the impulses originating from the duodenum. The purpose of the present study was to compare the short-term outcomes of uncut Roux-en-Y (URY) and Billroth II combined Braun (BB) anastomosis. METHODS:In this prospective, multi-center, two-arm randomized controlled trial, 124 patients with advanced distal gastric cancer were randomized into two groups: URY (n = 62) and BB (n = 62) groups. RESULTS:The mean gastric juice pH was significantly lower in the URY group compared with the BB group (3.94 ± 0.71 vs. 5.83 ± 0.91, P < 0.0001). The bile reflux gastritis at 3 months (P < 0.0001) and 6 months (P = 0.002) was significantly more frequent in the BB group. No recanalization occurred in the URY group, and no significant difference was found between the two groups in terms of mean operative time (P = 0.69), mean time to perform anastomosis (P = 0.86), mean estimated blood loss (P = 0.77), mean number of harvested lymph nodes (P = 0.90), time to first passage of flatus or defecation (P = 0.87), postoperative hospital stay (P = 0.83), and the incidence of postoperative complications (P = 0.70). CONCLUSIONS:URY anastomosis is associated with a significantly lower incidence of bile reflux gastritis and roux stasis syndrome compared with BB anastomosis.

摘要

背景: 胃癌腹腔镜远端胃切除术后传统 Billroth ⅱ 和 Roux-en-Y 吻合术分别与胆汁反流性胃炎和 roux 瘀滞证相关。未切开 Roux-en-Y 胃空肠吻合术可通过阻断胆汁和胰液进入残胃并保留起源于十二指肠的冲动来降低这些并发症的发生率。本研究的目的是比较未切割 Roux-en-Y (URY) 和 Billroth II 联合 Braun (BB) 吻合术的短期结局。 方法: 在这项前瞻性、多中心、双臂随机对照试验中,124 例晚期远端胃癌患者被随机分为两组: URY (n = 62) 和 BB (n = 62) 组。 结果: 与 BB 组相比,URY 组平均胃液 pH 值显著降低 (3.94 ± 0.71 vs. 5.83 ± 0.91,p <0.0001)。BB 组 3 个月 (p <0.0001) 和 6 个月 (p = 0.002) 的胆汁反流性胃炎发生率明显高于对照组。无再通发生 URY 组,比较差异无统计学意义,两组患者的平均手术时间 (P  =   0.69),平均吻合时间 (p = 0.86),平均估计失血量 (p = 0.77),平均淋巴结清扫数 (p = 0.90),至首次排气或排便的时间。(P = 0.87) 、术后住院时间 (p = 0.83) 、术后并发症发生率 (p = 0.70)。 结论: 与 BB 吻合术相比,URY 吻合术与胆汁反流性胃炎和 roux 瘀滞综合征的发生率显著降低。

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